How are we doing?
This is an important question - one we don’t take lightly because the answer helps us make better decisions that ultimately lead to better health for everyone.
Give us your feedback by participating in our 2016-2019 IHSP survey. The IHSP, which stands for Integrated Health Services Plan, is our roadmap for system change within the health care system. The survey helps us identify local priorities as we work with health service providers to improve the health of Waterloo Wellington residents over the next three years.
The survey, which takes approximately 15 minutes to complete, is available on our website in both French and English from March 2, 2015 to March 13, 2015. Participation in the survey is voluntary and confidential.
Your opinions matter and we very much look forward to hearing them. Together, we will improve – challenge – and transform the current system.
Bruce Lauckner, Chief Executive Officer, Waterloo Wellington Local Health Integration Network
Stories from our Community
Community Support Connections - Meals on Wheels and More’s (CSC) adoption of Toyota Production System practices and principles into the way it delivers services is now paying off.
The community organization, which is responsible for a variety of supports and services to help seniors and adults with disabilities to live in their own homes with independence and dignity, partnered with Toyota Motor Manufacturing Canada (TMMC) to learn their processes and adapt them to improve its own service delivery – starting with their transportation services.
“We identified many areas of improvement and we were able to turn a deficit of about $500 to a surplus of $285 a month. We changed some of the ways we were delivering our Cambridge transportation services to using a standardized mapping system and making better use of our in-house database software,” said Janis Doran, Transportation and Exercise Lead at CSC.
TMMC employees provided support including an in-house trainer on how to use the Process Board. “I learned a lot about how to visualize problems and solve them. It was amazing to see how many steps you can actually put into breaking down a problem,” says Mike Thompson, Transportation Scheduler - Volunteer Coordinator.
The success of this partnership was recognized by the Cambridge Chamber of Commerce. CSC and TMMC were honoured with the Corporate/Not for Profit Partnership Award.
“The people who work at TMMC really care about our community. Working with CSC was a great opportunity for us to collaborate and share some of our knowledge and expertise to invest in the services of our community. TMMC is very proud to have partnered with CSC to strengthen their organization,” says Stephanie Pollard, Vice President, Administration, TMMC.
Efforts are now underway to apply the same process to other departments within the organization to realize further efficiencies.
“We are already using the Toyota Business Practice in our volunteer program. Internally, we have always been looking at a process of continuous improvement but this process allows us to follow a more structured framework when looking for areas of improvement”, noted Janis.
CSC relies on the time and the dedication of 610 volunteers for its many programs which include delivering hot nutritious meals, transportation, community dining and escorted grocery shopping. According to Janis, the demand for service continues to grow and volunteers are always needed.
CSC, which serves more than 5,000 clients in the Waterloo Wellington, is also supported by the Waterloo Wellington Local Health Integration Network. Their programs help seniors access healthy food and exercise classes that keep them healthier and avoid the need for a trip to the hospital.
*Photo of Janis Doran with with the Corporate/Not for Profit Partnership Award
Jane’s husband Bill was admitted to hospital following a terrible accident. Like any other person, Jane expected her husband to live. Both she and Bill were not yet retired, living a healthy life and had never thought of having a meaningful dialogue about their preferences for the end-of-life. Bill had been on life support for more than a week when the doctor said, “I’m sorry, the news is not good. We have tried an operation to relieve pressure and drugs to reduce swelling. There are no other options to consider.” It was suggested that he be removed from the breathing machine.
Now was the time for a family meeting as Jane wanted to consult with her daughter and son on what decision she should make. No one was prepared for this difficult conversation. It was very emotional and difficult as Jane didn't know Bill’s wishes. Her children agreed with the doctor’s decision but Jane was not convinced that it was time yet. And so her husband continued to be in the intensive care unit with monitors and machines for a few more days while Jane questioned herself on what he would want if he could make the choice. Eventually Bill’s heart stopped two weeks after the accident. Jane and her family left the hospital emotionally drained and questioning whether the right decisions had been made.
This story demonstrates situations that reflect common experiences when people have to make difficult decisions about end- of-life care.
Why does Advance Care Planning Matter?
An Advanced Care Plan (ACP) is a plan that provides the resident, their family and caregivers an opportunity to consider what medical and social care a person would prefer, or refuse, during a time of crisis or end of life. This plan is more than a single document; it is a holistic view of the needs and wishes of a person during end of life care and should help to define the persons’ personal desires regarding their end of life. An ACP helps to facilitate conversation, provide direction and reflects a person’s wishes.
Jane’s story represents the reality for many residents in Waterloo Wellington. Health care decisions are being made at a most emotional time without clear knowledge of the wishes of the patient. This is why the Waterloo Wellington Advance Care Planning Education Program is essential. To help people like Jane and Bill and their family have earlier conversations about what kind of care they would want for themselves in the future should they become incapable of consenting to or refusing treatment and who they want to make those decisions on their behalf. Communicating those wishes to one’s family and health care providers is important.
The benefits of Advance Care Planning for individuals and their families include:
- Comfort in being prepared
- Enhanced autonomy of the patient
- Reduction of stress for substitute decision-makers
- Personal wishes are respected and followed
- Decreased potential for conflict within the family system
In Waterloo Wellington, there is the need for:
- Greater awareness and more consistent training for local health and social care practitioners and collaborations that connect to end-of-life care
- Standardized ACP protocols that are consistent with Ontario legislation
- Greater engagement of residents in ACP to increase understanding and awareness of patient rights, as well as reduce anxieties and uncertainties about planning for potential incapacity at the end-of-life.
- Greater engagement of the community stakeholders including lawyers, insurance brokers, and bankers to build their knowledge and contribution to promoting ACP
The Waterloo Wellington Local Health Integration Network (WWLHIN) Board of Directors approved an investment of $1.2 million over 3 years to Hospice of Waterloo Region to enhance the quality of care and the patient/family experience at end-of-life through improved Advance Care Planning for residents of Waterloo Wellington.
Celebrating the People in our Community
About a year ago, The Ministry of Health and Long-Term Care and the Ontario Medical Association made a commitment to fund special projects that provide extra support for patients with complex medical needs. One such project that received funding, through the Medically Complex Project, is the Geriatric Medically Complex Clinic (GMCC) at St. Mary’s General Hospital in Kitchener.
This one year demonstration project is transforming lives and the way geriatric patients with multiple, complex medical conditions access and receive care.
Lee-Ann Murray, Project Lead for the GMCC, explains why a project like this is so important. “In our Local Health Integration Network (LHIN) we have a significant proportion of the medically complex population who are geriatric patients who have conditions such as dementia, delirium, fractures and chronic pain as just a few examples. These conditions by themselves are challenging enough. However, in many cases these conditions can be aggravated by other factors such as cognitive decline, frailty and taking multiple prescription medications. When these individuals are unable to see a family doctor or other primary care provider, they resort to what we call safety net resources such as crisis teams and hospital emergency departments. This places a significant cost to the health system. We knew there was a more efficient, cost-effective way to help these patients.
“The GMCC combines resources into one team made up of health care professionals including: geriatricians, nurse practitioners, a clinical nurse specialist in geriatrics, elder focused pharmacist and social workers. This approach allowed us as part of this pilot to build and enhance upon three components of our local health system: Out-reach model of the frail elderly project (St. Mary’s), the Primary Care outreach for housebound frail elderly, and Outpatient Geriatric Services (St. Mary’s).”
The benefit of the clinic is the development of a targeted plan of care that allows patients to seamlessly transition from the emergency department (ED) or inpatient hospital care to community care. Clinic staff can also continue to provide care to patients within the community. The patient’s plan of care is created after a comprehensive assessment done by the clinical team and in collaboration with our community partners such as Community Care Access Centre (CCAC), Day Programs and Primary Care.
There are many success stories from the clinic’s first year and here is one example of how seamless, coordinated care helps people get back to their lives.
Betty is 78-years old. She lives alone in a small apartment. Her only family is a brother she hasn’t seen in many years. One day she began to experience foot pain. She visited the emergency department at St. Mary’s where she was assessed by a Geriatric Emergency Management (GEM) nurse who knew about the GMCC and helped Betty connect with appropriate staff. Patients need a referral to receive care at the clinic.
The pain in her foot was caused by infection and was treated in the emergency department. It wasn’t until Betty met with the social worker in the GMCC that a larger health story began to unfold.
Betty’s medical challenges are many. She’s been diagnosed with pre-diabetes and a thyroid condition. She suffers from obsessive compulsive disorder and as a result has become a hoarder. She also takes various medications that affect her moods, make her anxious and sometimes confused. In addition to her health concerns, she also struggles with some changes in her lifestyle that affect her overall health. Betty used to play piano. Now she can’t. She used to see her brother regularly. She lost that connection. But Betty is not always comfortable talking about her problems. The team at the GMCC worked to build a strong rapport with Betty and encouraged her to talk about her challenges.
The team at the GMCC prepared a comprehensive care plan for Betty that included treating her medical conditions, ensuring she had appropriate medications, coordinating a referral to a geriatric psychiatrist. They connected her with resources in her community to help her manage her daily life such as getting rid of the clutter in her apartment. Her social worker is also helping Betty to connect back with her social life including re-connecting with her brother. She is even looking forward to playing the piano again.
“I visited her the other day because it is important to see the patient in the home setting. You get a better sense of them and their life.” says Dr. Nicole Didyk, geriatrician and physician lead for the clinic. “You get the real picture of how they are coping. Her life had become so small and so it’s very gratifying to see her life change for the better.”
If you know an elderly person in the community who may be dealing with medical challenges, encourage them to see their family doctor or, in an emergency situation, visit a walk-in clinic or emergency department for a referral to the GMCC.
*Photo of Dr. Didyk and Lee-Ann Murray at the Geriatric Medically Complex Clinic
Meet Dr. Ian Digby, Waterloo Wellington Local Health Integration Network Emergency Department Physician Lead.
Dr. Ian Digby comes from a family of doctors. He is the 5th generation of physicians in his family.
Upon completing high school, it was no surprise for Ian to study undergraduate Science Studies at the University of Toronto, followed by a Doctor of Medicine at the University of Calgary in 1996. He then completed his Canadian College of Family Physicians, Family Practice residency and in 2005, he received a special certificate in Emergency Medicine from the Canadian College of Family Physicians.
Since September 2013, Ian has been the Waterloo Wellington Local Health Integration Network (WWLHIN) Emergency Department Lead. In his role, he works closely with members of the Emergency Department Integrated Program Council to develop new models for integration of Emergency Care in Waterloo Wellington. He also tours local Emergency Departments (ED) to help identify successful practices that can be implemented elsewhere and find areas for improvement.
“In 2008 to 2009, we did a project across the LHIN in all the hospitals. It was the first time we started to implement “lean” methods to make ourselves more efficient and to improve quality of care and we had a dramatic change after instituting those methods,” says Ian.
With regards to wait times in the Emergency Department, Ian points out that: “One of the main concerns of residents visiting our EDs is wait times. We have really come a long way in our region in reducing wait times “In April 2008, the time a patient waited to see a physician or nurse practitioner, for 9 out of 10 patients, was 4.1 hours. This time peaked at 5.5 hours in April 2012. Since then, improvements that have been made at local emergency departments have reduced this to 3.4 hours currently.”
He added: “Congratulations to the managers, directors and front-line workers in our hospitals who have worked so hard to improve care for residents. We will continue to work on best practices to shorten wait times.”
Ian has been the Chief of Emergency Medicine at Guelph General Hospital (GGH) since 2011 where he collaborates with physicians, nursing staff and administration to ensure quality of patient care in a high-volume ED. His other portfolios at GGH include the Mental Health Quality and Operations Team and he is a longstanding executive member of Guelph Emergency Medical Services.
He participated in a research project through the Improving and Driving Excellence Across Sectors (IDEAS) initiative which looked at best practice and patient experience in emergency care: “This training armed me with new skills in quality improvement to contribute to best practice care,” he said.
Ian has presented at various conferences on GGH’s ED process improvement. His membership includes
being an Assistant Clinical Professor (Adjunct) in the Department of Family Medicine at McMaster University, a member of the Canadian College of Family Physicians, the College of Physicians and Surgeons of Ontario, the Canadian Medical Protective Association, the Canadian Association of Emergency Physicians and the Canadian Medical Association/Ontario Medical Association.
Outside work, Ian is involved in a number of community activities. He is an Assistant Scouter with Guelph 1st Saint James Troop, and was a board member of Trillium Waldorf School and the Guelph Jazz Festival. In 2009, he received the Guelph Mercury Top Forty Under Forty Award for community volunteerism. He has been to West Africa - Mali, Ghana and Cote D’Ivoire.
Ian lives in Guelph and enjoys spending time with his wife Susan and two children. If he is not in the ED, you can find him outdoors – canoeing, hiking, running or biking.
eHealth Centre of Excellence recognized for a 2015 National Leading Practice Initiative
The eHealth Centre of Excellence (eCE)
is being recognized for a 2015 National Leading Practice Initiative by Canada Health Infoway and Accreditation Canada. The recognition is for the eCE’s Project Alive that explores how electronic medical records (EMRs) can be used in clinical environments to aid clinicians to improve their quality of care and to deliver more efficient and targeted care to their patients.
The Canada Health Infoway’s Leading Practice initiative recognizes digital health projects that are focused on strengthening clinical practice and improving the patient experience.
For more information visit the Canada Health Infoway website.